tbuckley/cabot-search huggingface dataset:
Predictive factors for cancer treatment delay in an underserved urban population.
Authors: Risha Sheni, Jiyue Qin, Shankar Viswanathan, Enrico Castellucci, Vikas Mehta
Journal: Journal of Clinical Oncology (2022)

136 Background: Incremental delays in time to treatment initiation (TTI) have been shown to cause a proportional, independent increased risk of disease specific mortality for breast cancer, colorectal cancer (CRC), head and neck (HNC), non-small cell lung cancer (NSCLC) and pancreatic cancer. Delays can partly be attributed to increasingly complex workup with modern imaging, genomic and multidisciplinary/multimodality treatments. However, studies suggest delays are associated with racial and socioeconomic disparities, implicating a target for addressing inequity. Given Montefiore Medical Center (MMC) serves a racially diverse, socioeconomically challenged population, we sought to evaluate associations between patient factors and TTI to identify those associated with delay. Methods: Retrospective cohort study at an urban community-based academic center of patients diagnosed with or referred for curative intent treatment of breast cancer, CRC, HNC, NSCLC and pancreatic cancer at MMC from January 2019 to December 2021. Variables of interest included tumor stage, primary treatment modality, median household income, Charlson Comorbidity Index (CCI) score, tobacco use, insurance type, language preference and inpatient (IP) admission or emergency room visit 30 days prior to diagnosis. Results: A total of 2543 patients (F = 1755, M = 788) were identified (mean age 63.4 ± 13.4). The median TTI was 25 days (6, 44 IQR). Factors associated with TTI delay were assessed using logistic regression (Table). Patients who were treated outpatient, and not admitted 30 days prior to diagnosis, experienced increased delay for CRC (OR 2.82) and NSCLC (2.11). Higher CCI score was associated with delay for HNC (2.63) and NSCLC (1.75). For breast cancer, uninsured and Spanish-speaking patients (1.79) were subjected to increased TTI. Conclusions: This study identifies predictors and opportunities for addressing delay and health inequity while improving survival. IP admission 30 days before diagnosis was associated with timely TTI for CRC and NSCLC. Other factors predictive of delay included CCI score in HNC and NSCLC, and insurance type and preferred language in breast cancer.[Table: see text]
Home-based geriatric oncology care: A feasibility study.
Authors: Gonca Ozcan, Julie Braish, Turab J Mohammed, Catriona Hong, Nicole Mott, Mary Eanniello, Armin Shahrokni, Andrew L. Salner, Peter Paul Yu, Ryan David Nipp, Rawad Elias
Journal: Journal of Clinical Oncology (2022)

62 Background: The Comprehensive Geriatric Assessment (CGA) improves the outcomes of older patients with cancer, and by identifying of geriatric impairments the CGA can guide the development of supportive interventions. However, the implementation of these interventions in a real-world setting can be burdensome for patients, particularly when additional visits are required in an often frail population. Therefore, our team developed a collaborative model for home-based delivery of CGA-guided interventions. Methods: We performed a retrospective review of community-dwelling patients aged ≥ 70 years with an active cancer diagnosis who were deemed to be frail by a CGA and who received home-based CGA-guided supportive interventions under a collaborative care model established by the geriatric oncology and the palliative home care teams at Hartford HealthCare Cancer Institute between October 2020 and April 2022. The collaboration is based on multidisciplinary discussion of the CGA results / interventions and weekly rounds to discuss patient’s progress and emerging needs. Results: A total of 182 patients received a CGA during the study period, 54% (n = 99) were determined to be frail based on impairment in ≥ 7 geriatric domains. Among all eligible patients, 19 patients (19%) were included in the collaborative model. The median age of enrolled patients was 84 years (74-90), 12/19 (63%) had metastatic cancer, 7/19 (37%) received systemic treatment, and 8/19 (42%) received radiation. The average number of geriatric impairments per patients was 9.5 (7-12). Geriatric impairments addressed at home were skilled nursing (19/19), physical therapy (18/19), occupational therapy (12/19), speech-language-pathology (2/19), nutrition (5/19), or social worker (11/19) support at home. The average number of unplanned hospitalizations was 1.16 per patient (range 0-4), and the average unplanned emergency room visit was 0.89 per person (range 0-4) during study time. Transition to hospice occurred in 8/19 patients (42%), the median time to transition to hospice was 33.5 days (15-167). Conclusions: This study demonstrates the feasibility of a collaborative model for home-based geriatric oncology care in a real-world setting to help reduce the burden of care on patients and ensure patient-centered delivery of CGA-guided interventions. Findings underscore the need for future work to evaluate the impact of this novel geriatric oncology care model on patient outcomes.
Associations between insurance status and the cancer clinical trial enrollment process.
Authors: Nicole E. Caston, Fallon Lalor, Jaclyn Wall, Jesse Sussell, Shilpen A. Patel, Courtney Williams, Andres Azuero, Rebecca Christian Arend, Margaret Irene Liang, Gabrielle Betty Rocque
Journal: Journal of Clinical Oncology (2022)

85 Background: Most patients with cancer experience multi-leveled barriers to clinical trial participation, potentially including financial concerns due to the complexity surrounding trial-related insurance coverage. Our study sought to understand the association between insurance status and cancer clinical trial eligibility, offer, and enrollment. Methods: This retrospective cohort study included patients with breast or ovarian cancer receiving a therapeutic cancer drug at the University of Alabama at Birmingham between January 2017 and February 2020. Available clinical trials and eligibility criteria were abstracted from OnCore and ClinicalTrials.gov. Patient trial eligibility, offer from provider, demographics, and clinical characteristics were abstracted from electronic medical records. Patient trial enrollment was determined via OnCore. Odds of clinical trial eligibility, offer, and enrollment by insurance status (private, public [Medicaid, Medicare]) were estimated using logistic regression models. Models estimating odds of trial offer and enrollment contained only eligible patients. Models were adjusted for patient age at diagnosis, race and ethnicity, rural-urban residence, Area Deprivation Index, cancer type, and cancer stage (early, late). Results: A total of 513 patients with breast (71%) or ovarian (29%) cancer were included in our analyses. Median age at diagnosis was 60 (interquartile range: 49-67) years; the majority were White (69%) and had early stage cancer (65%). Half of patients had private insurance (54%), and 46% of patients had public insurance (38% Medicare, 8% Medicaid). Patients with private insurance more often had early stage cancer compared to patients with public insurance (73% vs 57%). Almost two-thirds of patients (65%) were eligible for clinical trial enrollment. Of eligible patients (n = 333), 68% were offered a trial and 47% enrolled onto a trial. In adjusted analyses, patients with public vs private insurance had similar odds of clinical trial eligibility (odds ratio [OR] 0.95, 95% confidence intervals [CI] 0.61-1.48), being offered to participate (OR 1.23, 95% CI 0.71-2.14), and clinical trial enrollment (OR 1.13, 95% CI 0.68-1.89). Conclusions: Our results suggest oncologists do not assess trial eligibility or offering a trial based on insurance status, and patients do not differentially participate based on their insurance coverage. Further research is needed to understand implications of trial participation (e.g., out-of-pocket and time costs) for patients covered by differing insurance.
Palliative care usage in metastatic thyroid cancer: An analysis of the National Cancer Database.
Authors: Michelle Swedek, Xinxin Wu, Timothy Dean Malouff, Peter T. Silberstein
Journal: Journal of Clinical Oncology (2022)

196 Background: Metastatic thyroid cancer portends a poor prognosis, especially in patients over the age of 55 or in more aggressive histologies, such as anaplastic. Palliative care (PC), which focuses on improving the quality of life in patients with severe disease, may be beneficial to these patients. To our knowledge, there has yet to be a study describing the demographic and usage factors associated with PC in metastatic thyroid cancer. Methods: We conducted a retrospective analysis of the National Cancer Database (NCDB) from 2004-2017 for subjects with metastatic thyroid cancer (n = 5,229) of all histologies. Analysis was completed between patients who utilized PC (n = 826) and patients who did not use PC (n = 4,403). The NCDB defines palliative care as care provided to alleviate or palliate symptoms, including radiation therapy, surgery, pain management, and/or systemic therapy. PC usage and survival were compared between cancer subtypes. Demographic factors were analyzed using Pearson chi-squared tests and t-tests, while survival was estimated using Kaplan-Meier curves. Results: Of the subjects with metastatic thyroid cancer, 50.6% had papillary, 25.2% had anaplastic, 15.9% had follicular, and 8.3% had medullary thyroid cancer. Anaplastic, medullary, follicular, and papillary metastatic cancers had median survivals of 2.4, 19.9, 49.5, and 55.3 months, respectively (p &lt; 0.001). PC usage increased between 2004 (3.4%) and 2017 (11.4%) across all subtypes. The mean age at diagnosis of PC patients was 69.2 years old compared to 66.9 years old for non-PC patients (p &lt; 0.001). Anaplastic thyroid cancer made up the greatest proportion of PC usage (42.5%) compared to other histologies (p &lt; 0.001). Subjects of Spanish/Hispanic origin received PC at lower proportions (p &lt; 0.001). In addition, Asian patients made up a smaller fraction of the PC cohort (4.2%) compared to the non-PC cohort (6.7%) (p = 0.028). Patients with private insurance made up a smaller proportion of PC users (26.5%) compared to non-PC users (35.6%), while subjects with government insurance or no insurance made up a greater proportion of PC usage (p &lt; 0.001). Less PC usage was seen by patients who lived in an area where greater than 17.6% of individuals did not attain a high school degree; these patients made up 25.3% and 19.9% of the non-PC and PC cohorts, respectively (p = 0.006). Patients who received PC tended to live closer to the reporting hospital (p = 0.007). No statistically significant difference was seen between PC and non-PC cohorts for income and facility type. Conclusions: In this study, we highlighted several disparities in PC usage across common types of thyroid cancer. We also compared usage between categories and noted a greater proportion of PC usage in recent years. Our study is a valuable baseline as PC continues to be integrated in cancer care.
Developing a standardized approach to prevention and outpatient management of febrile neutropenia.
Authors: Andrea Crespo, Daniela Gallo-Hershberg, Katherine Enright, Leta Marie Forbes, Kathy Vu
Journal: Journal of Clinical Oncology (2022)

234 Background: Optimal prevention and safe management of febrile neutropenia (FN) in the outpatient setting, when clinically appropriate, can help to keep vulnerable patients from experiencing severe complications requiring hospitalization. Variation in the prevention and outpatient management of FN was identified as a quality and safety gap by Ontario clinicians. This initiative aimed to facilitate a standardized approach to prevention and outpatient management of FN through the development of practical, evidence-based health-care provider and patient resources. Methods: A clinical practice guideline was developed by a 15-member multidisciplinary Working Group (WG) consisting of physicians, pharmacists, nurses, and administrators who are knowledgeable in the areas of prevention and management of FN. The WG reviewed current relevant international guidelines and available literature on primary and secondary FN prophylaxis and FN management, with an emphasis on the optimal use of granulocyte colony-stimulating factor (G-CSF) and appropriate FN management in the outpatient setting. The 2016 Cancer Care Ontario recommendations on the use of G-CSF were used as a foundation for the prevention of FN content. Key clinical questions were identified by the WG, and content was approached with an Ontario-specific lens. Recommendations were developed using an iterative consensus-building process over six WG meetings. The guideline report was reviewed by external clinical experts who validated final content. Accompanying patient information was informed by health literacy best practices, existing symptom management resources, and input from patient education experts, patients, and caregivers. Results: A user-friendly clinical practice guideline was created. Definitions, risk factors, FN prophylaxis strategies based on risk/treatment intent, and appropriate outpatient management of FN are described. Key clinical questions are reviewed and a total of 25 evidence-informed consensus-based recommendations are presented. The guideline includes FN risk assessment and outpatient FN management algorithms, as well as summaries of available literature and WG discussion. The accompanying patient information explains what neutropenia and neutropenic fever are, lists potential symptoms, and describes management strategies in patient-friendly language. All resources are publicly available on the Ontario Health-Cancer Care Ontario website and have been disseminated broadly to relevant stakeholders via email, social media, and webinars. Conclusions: Review of current evidence and expertise from oncology and infectious disease clinicians resulted in an evidence-informed, consensus-based guideline. This clinical practice guideline and accompanying patient information resource can help to facilitate safe, standardized prevention and appropriate outpatient management of FN.
Rural-urban disparities in uptake of lung cancer screening.
Authors: Soumya J. Niranjan, Desiree Rivers, Rekha Ramchandran, Edward Murrell, Sejong Bae, Mark T. Dransfield, Isabel C. Scarinci
Journal: Journal of Clinical Oncology (2022)

119 Background: In Alabama, lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low-income, and rural populations. Residents in rural Alabama tend to be older, engage in risky health behaviors, and have lower adherence to preventive care than their urban and suburban counterparts. Disparities in mortality rates between rural and urban areas are substantial for lung cancer. It can be explained by increased tobacco use and the preponderance of late-stage diagnoses following the lack of uptake of lung cancer screening (LCS). Therefore, we examined factors associated with LCS uptake among patients referred for screening at the University of Alabama at Birmingham (UAB). Methods: A retrospective cohort of patients at UAB who were eligible for lung cancer screening between 01/01/2015 and 12/31/2020 was used to define the cohort. Eligibility was defined as individuals between 55-80 years old, without diagnostic codes for lung cancer (ICD-9 162.9 or ICD-10 C34.90 within the past ten years), and had a smoking history. Patient demographic variables included Age, Sex, Race/Ethnicity, RUCA codes, and distance from UAB. Chi-square tests and Student t-tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate analyses were used to determine significant predictors of lung cancer screening uptake at UAB. Results: Of the 67,355 identified as eligible for LCS, only 1147 (0.017%)were screened. Sixteen individuals were not AL residents and therefore were not included in further analysis. Of those 1129 individuals screened, the mean age was 67.02, male (54.92%) and Non-Hispanic White (57.77%). Compared to those not screened (97.86%), those screened (2.14%) were more likely to live in an urbanized area. Additionally, compared to those not screened (50.52 mi), those screened were more likely to live closer to UAB (22.06 mi). Conclusions: Findings show a substantial disparity between adults living in rural areas and those living in more urbanized areas regarding LCS use. Furthermore, the study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake.
Palliative care utilization and mortality in patients who received inpatient chemotherapy.
Authors: Justine Anderson, Shivani Handa, Giulia Petrone, Nobel Chowdhury, Deukwoo Kwon, Aarti Sonia Bhardwaj, Priya Jain, Cardinale B. Smith, Natalie S Berger
Journal: Journal of Clinical Oncology (2022)

198 Background: Early integration of palliative care (PC) into advanced cancer care has been shown to improve quality of life and prognostic understanding. However, there is a paucity of data on utilization of inpatient PC consultation and survival outcomes in patients (pts) receiving inpatient chemotherapy (IC). Methods: A retrospective review was performed at a single academic center of pts receiving IC between Jan 2016 and Dec 2017. We evaluated utilization of PC services, reasons for consult, code status, disposition, and 60-day mortality. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect, taking into account correlations from multiple admissions per patient. Cumulative incidence plot and Cox proportional hazard regression models were used to assess the association between mortality and study covariates. Results: Of 880 admissions, 733 (83%) were hematologic malignancies (HM) and 147 (17%) were solid tumors (ST). PC consults were more likely in ST than HM (OR 3.19, 95% CI 1.85 - 5.50) and for KPS ≤50% (OR 22.20, 95% CI 11.51- 42.79). Of 159 PC consults, 91 (57%) were for pain and 25 (16%) for goals of care. 66 pts (10%) who received IC died within 60 days of admission, 44 (67%) HM and 22 (33%) ST (p = 0.002). In pts who died within 60 days, 63% had PC consult. Median time from admission to PC consult was 2 days for ST and 9 for HM. Of those with PC consult, 40% had a change from full code to DNR/DNI and were more likely to have a health care proxy (HCP) assigned (OR 7.31, p = 0.001). PC consults were also associated with significantly higher odds of discharge to hospice (OR 10.52, 95% CI: 4.3-25.6; p = &lt; 0.0001; Table). Mortality risk was higher in those admitted for symptoms/complications related to their disease or with progression (HR 3.24, 95% CI (2.50-4.19), p &lt; 0.001) and in those with advanced stage disease: Stage 3 (p = 0.033); Stage 4 (p = 0.0003). Of the pts who died within 60 days, 33 (50%) died during the admission and 24 (36%) in hospice. Conclusions: Significant 60-day mortality after receiving IC is consistent with aggressive end-of- life care. Pts with ST and those with poor performance status more frequently utilized inpatient PC services; however, there is opportunity to increase utilization amongst pts with HM and introduce PC earlier in the inpatient clinical course. PC consultations improve advanced care planning with appropriate transitions in code status, HCP assignments and discharge to hospice.[Table: see text]
Impact of biopsychosocial screening program on hospital admissions: Observational study from a Brazilian cancer center.
Authors: Cristiane Decat Bergerot, Paulo Gustavo Bergerot, Lorena Nascimento Manrique Molina, Alici Natalia de Sousa Freitas, Karla Lúcia Lucia Nascimento, Errol James Philip, David Lee, Luana Sacchi, Jose Nazario, Natalia Barros Salgado Vieira, Joao Nunes Matos Neto, Marco Murilo Buso, Enrique Soto Pérez de Celis, Narjust Florez
Journal: Journal of Clinical Oncology (2022)

72 Background: The integration of biopsychosocial screening programs (BSP) has been promoted as a way by which to identify unmet needs and to provide tailored treatments to patients. Studies have reported mixed outcomes regarding the impact of such services on hospital admissions during cancer treatment. This study sought to evaluate the effect of a BSP on hospital admissions and length of stay among a large, heterogenous sample of patients diagnosed with cancer (March 2020 to December 2021). Methods: We enrolled consecutive patients diagnosed with cancer receiving treatment at a single institution located in the capital of Brazil. We assessed patients’ characteristics via chart review (e.g., age, sex, histology, hospital admission, length of hospitalization). In addition, as per the BSP protocol, patients were assessed via standardized self-report questionnaires (Distress Thermometer, FACT-G, Patient-Generated Subjective Global Assessment), and appropriate interventions are provided. This program was offered at no cost to all patients and engagement was voluntary. We compared the number of hospital admissions and length of stay between groups (patients who participated in the BSP vs. those who did not). Mixed linear models adjusted for selected characteristics (age, type of cancer and disease stage) were assessed. Results: A total of 1014 patients were included in this analysis. From the total sample, 84% participated in the BSP and 20% were hospitalized for an average of 9 days (ranging from 1-80 days). Mostly patients were female (63%), median age was 63 years old. Breast cancer (26%), hematological (18%), and gastrointestinal cancer (14%) were the most common types of cancer, and the majority had advanced disease (stage III-IV; 67%). Compared to those who engaged in the BSP, patient’s characteristics were well balanced, however, the proportion of patients hospitalized during their cancer treatment was higher among patients who did not participate in the BSP (27% vs 8%: P = 0.001), as was the length of hospitalization spent more days in the hospital than patients who has participated in the BSP (M = 9.5 days vs M = 4.2 days; P = 0.001). Conclusions: Our findings suggest the benefit of a BSP in reducing hospitalizations and length of stay among patients with cancer. An integrated model of care may assist in targeting patient’s unmet needs and may positively impact clinical and hospital-based outcomes. This is the first study to evaluate the effects of a BSP among a Brazilian population using real world data.